What role does a clinical trial investigator’s race play in determining the participant pool? from Harvard Kennedy School Angelopoulos Professor of Public Policy Marcella Alsan and her co-authors found that Black participants’ interest in clinical studies increased by 12.6% when the study was led by a Black principal investigator.
Black Americans are underrepresented in clinical trials: Despite accounting for 13% of the U.S. population and suffering disproportionately from certain conditions, only 5% of clinical trial participants in the United States are Black. A lack of representation in clinical trials could compromise the validity of research conclusions, reduce opportunities to benefit from medical innovation, and contribute to increasing racial disparities in morbidity rates.
According to the authors, one reason for this underrepresentation is a lack of trust in the medical profession. “Increasing trust among Black communities requires the medical profession to become more trustworthy,” the authors write. “Part of building trust is increasing the opportunity for members of underrepresented groups to be in positions of authority, including as principal investigators and physicians.” Racial concordance—when the principal investigator and the potential participants are the same race—“can improve enrollment of underrepresented racial minorities in medical research by projecting trustworthiness,” the authors write.
“This research was motivated by a desire to give all patients the opportunity to participate in clinical trials—which has inherent risk but also can be the only way to access life-saving innovative treatments,” Alsan said.
“This research was motivated by a desire to give all patients the opportunity to participate in clinical trials—which has inherent risk but also can be the only way to access life-saving innovative treatments.”
The research, which was published in the Journal of Health Economics, was authored by Alsan, Romaine Campbell PhD 2024, Lukas Leister, of the Universitat Pompeu Fabra, and Ayotomiwa Ojo, of Northwestern Memorial Hospital. The study included a survey of 323 Black Americans, who were shown a randomized series of photographs of current National Institutes of Health investigators and asked how interested they would be in taking part in a trial led by these investigators. Participants were then asked to rate the investigators based on their perceived age, education level, trustworthiness, attractiveness, and qualifications.
Campbell, currently a Provost Faculty Fellow at Cornell University, was a Stone PhD Scholar in the Malcolm Wiener Center's James M. and Cathleen D. Stone Program in Wealth Distribution, Inequality, and Social Policy. “Our results suggest that we should be deliberate about diversity among medical professionals. In the short-term, there may also be benefits to more strategic placement of the existing pool of principal investigators,” Campbell said.
The authors warn, however, that challenges remain even if investigator diversity is increased. “While better representation of Black and other historically marginalized groups may be an effective tool for encouraging participation in clinical studies,” the authors write, “it is not likely to be a comprehensive solution given the structural barriers to accessing medical care and obtaining information on trial opportunities as well as the time and financial burden imposed on participants.”
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